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Sports activity after pelvic osteotomy for treatment of developmental dysplasia of the hip

A comparative study between the triple pelvic and periacetabular osteotomy techniques

Sportaktivität nach Beckenosteotomie zur Behandlung einer Hüftdysplasie

Vergleichsstudie zwischen den Verfahren der dreifachen Becken- und der periazetabulären Osteotomie

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Abstract

Background

Symptomatic dysplasia of the hip represents an indication for a bony correction of the acetabulum. In the last decades several operative procedures were established.

Objective

The aim of the current study was to analyze whether the level of sports activity is higher in patients after periacetabular osteotomy (PAO) according to Ganz as a technique which preserves the posterior column compared to classical triple pelvic osteotomy (TPO) for treatment of developmental hip dysplasia.

Material and methods

The study group included 102 patients treated with the classical TPO with already published clinical results, who were compared to 34 patients treated with PAO between 2012 and 2016. The clinical outcome scores included the modified Harris Hip Score, the Hip Osteoarthritis Outcome Score, the University of California, Los Angeles activity score and the visual analog scale.

Results

After a mean follow-up of 4.4 years the clinical parameters improved significantly after PAO (p < 0.05). In comparison to the TPO group the clinical scores of the PAO group had inferior baseline values and a tendency to inferior follow-up results in the mHHS (p < 0.05) and HOOS (p > 0.05). After surgery, the PAO group showed a shift to medium and high impact sport activities.

Conclusion

The shorter time of postoperative partial weight bearing after PAO due to the preservation of the posterior column seemed not to have a positive impact on the clinical results or the sports activity compared to the TPO treated patients.

Zusammenfassung

Hintergrund

Die symptomatische Hüftdysplasie des Erwachsenen bedarf in der Regel einer knöchernen Korrekturosteotomie, um die mechanische Kraftübertragung vom Azetabulum zum Femurkopf zu verbessern. Über die Zeit haben sich mehrere Operationstechniken etabliert.

Ziel der Arbeit

Das Ziel der Studie war es, das Aktivitätsniveau zwischen Patienten nach einer Tripel-Osteotomie (TPO) und einer periazetabulären Osteotomie (PAO) nach Ganz zu vergleichen. Ein wesentlicher Unterschied zwischen beiden Verfahren ist der Erhalt des hinteren Pfeilers bei der PAO.

Material und Methoden

Die Studiengruppe enthielt 102 Fälle, die mit der klassischen TPO behandelt worden waren und deren klinische Ergebnisse bereits publiziert wurden. Sie wurden mit 34 Patienten verglichen, die mit einer PAO bei symptomatischer Hüftdysplasie zwischen 2012 und 2016 versorgt worden waren. Die klinischen Bewertungsmaßstäbe umfassten den modifizierten Harris Hip Score (mHHS), den Hip Osteoarthritis Outcome Score (HOOS), die Aktivitätsskala der University of California Los Angeles und die Visuelle Analogskala.

Ergebnisse

Nach einem durchschnittlichen Beobachtungszeitraum von 4,4 Jahren zeigte sich eine signifikante Verbesserung in den Bewertungsmaßstäben nach durchgeführter PAO (p < 0,05). Im Vergleich zu der TPO-Gruppe zeigten die PAO-Patienten niedrigere Ausgangswerte in den Bewertungsmaßstäben und tendenziell niedrigere Ergebnisse im mHHS (p < 0,05) und HOOS (p > 0,05). Nach der Beckenumstellung zeigte sich ein Wechsel von Sportarten mit mittlerer Belastung zu Sportarten mit hoher Belastung.

Schlussfolgerung

Die kürzere Phase der Teilbelastung nach PAO aufgrund des Erhalts des hinteren Pfeilers scheint keinen positiven Einfluss auf die klinischen Ergebnisse oder die sportliche Aktivität im Vergleich zu Patienten mit TPO zu haben.

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Abbreviations

AA:

Acetabular angle

DDH:

Developmental dysplasia of the hip

HOOS:

Hip Osteoarthritis Outcome Score

LCEA:

Lateral center edge angle

MHHS:

Modified Harris Hip Score

PAO:

Periacetabular osteotomy

ROM:

Range of motion

THA:

Total hip arthroplasty

TPO:

Triple pelvic osteotomy

UCLA:

University of California, Los Angeles activity score

VAS:

Visual analog scale

WOMAC:

Western Ontario and McMaster Universities Osteoarthritis Index

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Diakovere Annastift (Hannover Medical School), Hannover, Germany

    Nils Wirries, Corinna Posselt,  Max Ettinger,  Alexander Derksen &  Henning Windhagen

  2. Department of Orthopaedic Surgery, Klinikum Bethel, Bielefeld, Germany

    Stefan Budde

  3. go:h Gelenkchirurgie Orthopädie: Hannover, Bertastraße 10, 30159, Hannover, Germany

    Thilo Floerkemeier

Authors
  1. Nils Wirries
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  2. Corinna Posselt
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  3. Max Ettinger
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  4. Alexander Derksen
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  5. Stefan Budde
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  6. Henning Windhagen
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  7. Thilo Floerkemeier
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Corresponding author

Correspondence to Thilo Floerkemeier.

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Conflict of interest

N. Wirries, C. Posselt, M. Ettinger, A. Derksen, S. Budde, H. Windhagen and T. Floerkemeier declare that they have no competing interests.

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The study was IRB approved by the local ethics committee (No. 3588).

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Wirries, N., Posselt, C., Ettinger, M. et al. Sports activity after pelvic osteotomy for treatment of developmental dysplasia of the hip. Orthopädie 51, 775–780 (2022). https://doi.org/10.1007/s00132-022-04249-2

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